License To Kill Or Seriously Injure Highlands Hospital
Tucked away in the third paragraph of yesterday's Herald Standard article, "
Hospital controversy still
unresolved," was the whole reason that so many are in an uproar over the pot of money that covers Fayette
County's inpatient psychiatric funds:

"Ambrosini said that his initiative to bring Highlands Hospital Chief Executive Officer Michelle Cunningham
and Uniontown Hospital President and Chief Executive Officer Paul Bacharach together along with other
healthcare professionals together hit a stumbling block last month when questions arose about Uniontown
securing a license to provide inpatient psychiatric services for residents enrolled in a state health care program."

Maybe it was that mere sip of courthouse water this editor drank the other day... but something Commission
Chairman Al Ambrosini said above made perfectly clear sense. In turn, the whole idea of the three-week debate
over the issuance of a medicaid provider number nearly became a moot point.

And before finishing reading that last part of the third paragraph about over a second time, email from another
trusted source, a former state hospital administrator, who maintained from last week that the real issue at hand
with Fayette's situation was the bloody license.

The "license" that Uniontown Hospital received a few years ago, when it branched out into inpatient geriatric
psychiatric services, became its 2012 pass to automatically get the issuance of a second Medicaid provider
number to treat patients ages 18-55.

Sources come from all different places, and that former frequent contact from days long ago, the former
psychiatric hospital administrative guru-type, mind you, sent lots of hyperlinks to lots of documentation to
support this situation. His last link sent was to the one in the local paper quoted above.

So this coming week's drama, it seems, will be to learn who gave the nod for the license and for the county
administrator of the behavioral department to explain why Highlands Hospital receives less per patient than
Uniontown Hospital does for the same service... as well as to answer whether approval was made for the
issuance of a second medicaid provider number for Uniontown Hospital. Those things -- with possibly an
exception for changing rates to equal amounts -- are a done deal that cannot be undone, so why bother?

County residents, politicians of Fayette County and employees of Highlands Hospital really deserve to know
exactly what was going on  -- i.e., who provided the approval -- when a medical hospital applied a few years ago
for a license to expand to inpatient psychiatric services and why the rates differ per hospital.

The state office of mental health had to have been onboard or approve the very crucial first of what is several
steps for any medical facility to branch out into psychiatric inpatient services. It's the first hurdle. There's no
way around it. Which local phone would have rung concerning this matter?

That said, we point out another famous regulation or law -- i.e., the Bible of community mental health services --
that has been around some 46 years. Managed behavioral health care did not change or rewrite the Mental Health
Law of 1966 or the state codes written to implement it into practice that followed.

As per Pennsylvania Code Title 50, Section 7105 of the Pennsylvania Mental Health Laws and
Regulations regarding treatment facilities, "Involuntary treatment funded in whole or in part by public
moneys shall be available at a facility approved for such purposes by the county administrator (who shall
be the County Mental Health and Mental Retardation Administrator of a county or counties, or his duly
authorized delegate), or by the Department of Public Welfare."

Our county's mental/behavioral health director is back at work after two long weeks off, as this column reported
on the first of this month. She knows what went down. Whether she gave the first nod of approval, or if the
state stepped in and did it for her, needs to be known, both for the license and issuance 5 months ago of a
second medicaid provider number in Uniontown.

As per Section 5100.12 of that same treatment facilities regulation, section (f): "The administrator shall
publicaly designate which approved facilities are available to provide involuntary emergency
examinations, involuntary treatment or voluntary treatment funded in whole or in part by MH/MR

Did anyone outside her own office ever hear her mention or announce a new facility to treat persons aged 18-55?
Were high utilizers of community mental health services told that Uniontown Hospital became a whole different
kind of hospital last March?

No. Nobody outside the county office and one, possibly two hospitals were aware until mid-July, when the
Highlands Hospital CEO wrote a letter to county commissioners and seemed to inform everyone else. When
would the rest of us have known if the Highlands CEO hadn't written her letter?

It is time that the county mental/behavioral health director spills the beans to her bosses and to the people who
pay her salary. We need to know details as to who offered a letter of support, approved or influenced the state
office of mental health to give that first level of clearance or approval for a medical facility a few years ago to
expand into psychiatric services. We feel that it's time the county behavioral health director cops to the truth.
And should it be the case that someone in a powerful position pressured her or pushed for this or lobbied the
state behind her back, she needs to say so.

And it's really a long overdue time for Ambrosini to get up to speed and acknowledge that the folks at Highlands
Hospital have every right to feel betrayed. Not only for what has happened, but because he won't sit down and
talk with them without bringing along the Uniontown CEO.

It was just a sip of water this editor drank at the courthouse the other day. Unlike Ambrosini, who told the paper
yesterday that there was no objection to Brownsville Hospital offering a "comprable service."  Of course, there
was no objection in that case.

This editor points out again how silly and wrong his comparison is. Geriatrics at Brownsville and a new
Uniontown unit serving patients ages 18-55 are two completely different things.

No amount of courthouse water will change that fact for us.

3 Aug 12
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